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The high impact areas: a multi-agency approach to the two-year review by Lynn Evans

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The six high impact areas articulate the contribution of health visitors to the 0-5 agenda and describe areas where health visitors have a significant impact on health and wellbeing and improving outcomes for children, families and communities. One of these areas is the two year review, which health visitors in Birmingham are using to work better with the wider system. This is also a universal health visiting review offered to all families.

The two to two and a half review is a crucial time when certain behavioural issues or problems to do with speech and language become apparent. This review is hugely important to help health visiting teams see if a child is developing well and crucially, getting ready for formal education. It’s also one of the six high impact areas where we know health visiting can make the biggest difference. Data quality on completion of these reviews in Birmingham was an issue due to differences in recording the number of ‘did not attends’ (DNAs).

Throughout 2014 we have continued to improved data quality by more consistently recording these DNAs so that we can start to address the reasons for this.

In the middle of last year, we achieved 60% uptake of the reviews. In order to build on this we have set up a multi-agency steering group and are developing a model to conduct integrated reviews with the local authority, early years sector, and private and voluntary sector.

Health visitors and nursery nurse staff have received training in the Ages and Stages tool which is now the nationally recommended development screening tool.

We have also consulted with teams achieving in excess of 85% uptake on how they approach the reviews so we can learn from them to incorporate good practice into our work with parents. One thing they do is to call parents prior to appointments.

This has had a good outcome in a short space of time. Uptake of the reviews is beginning to rise, and was 67% in September 2014. It’s also improved awareness among health visiting teams of the value of the reviews which they can then share with parents.

We have also tried to integrate better with colleagues from across the system and health visitors and nursery nurse staff are trained to use the same tool.

There has been unanimously good feedback from parents about the 2 year review being conducted in partnership with their early years day care setting. It’s also helped increase knowledge of the role of the health visiting service amongst early years education providers.

So, what’s next? The team is continuing to support teams to introduce a community development approach to raising the importance of the review with parents. We also want to agree on a text reminder system to improve DNA rates even more.

Lynn Evans, Health Visitor Implementation Programme, Birmingham



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